ADHESION MOLECULE EXPRESSION IN VENOUS LEG ULCERS

The final stage of chronic venous insufficiency (CVI) is ulceration. S everal theories have been suggested to explain the skin changes and ul cerations. However, none of these can fully account for all the altera tions which occur. Adhesion molecules are considered to play an import ant role in inflammatory reactions and in the process of wound healing . The aim of our study was to investigate the expression of intercellu lar adhesion molecule-1 (ICAM-1), endothelial leucocyte adhesion molec ule-1 (ELAM-1), and vascular cellular adhesion molecule-1 (VCAM-1) in venous leg ulcers. Skin biopsies from 8 patients were taken from the s urrounding skin of venous ulcers. ICAM-1 showed a weak to moderate exp ression on the endothelium of capillaries directly below the venous ul cer. A moderate expression of ICAM-1 was found on capillaries in the p apillary dermis around the ulcus, similar to that of normal controls. A strong expression of ELAM-1 was only found on capillaries in the inf iltrate directly under the ulcer. Some specimens also showed a moderat e expression of ELAM-1 around the ulcus. Expression of VCAM-1 was subs equently found to be negative in all patients. The results suggest a d isturbed inflammatory reaction in venous leg ulcers. In the area aroun d the ulcer, where healing should initiate, the adhesion of monocytes and lymphocytes to the endothelium and the migration of these cells to the wound area were found to be insufficient.